微创技术在腹腔镜胆囊切除术后黄疸诊治中的应用

THE DIAGNOSIS AND TREATMENT OF JAUNDICE FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY WITH THE MINITRAUMA TECHNIQUE

目的 探讨微创技术在腹腔镜胆囊切除术 (L C)后黄疸的诊断与治疗中的作用。方法 在微创观念指导下 ,对L C术后出现黄疸的患者运用内镜逆行胰胆管造影 (ERCP)和内镜括约肌切开 (EST)等微创技术进行诊断与治疗。结果 我院 1998年 8月至 2 0 0 1年 5月间共行 316 0例 L C手术 ,术后出现黄疸者 5例 ,均先接受 B超、ERCP检查 ,提示胆总管结石与胆总管末端狭窄。3例 EST取石一次成功 ,1例首次 EST取石失败后予保守治疗 5天后再行 ERCP与碎石治疗成功 ,1例因结石较多较大行开腹胆总管探查术。结论 对 L C术后黄疸 ,在 B超等检查排除明显胆道损伤和胆漏后 ,胆总管结石应首先考虑。ERCP可进一步明确诊断 。

Objective To evaluate the value of minitraumatic technique in the diagnosis and treatment of jaudice following laparoscopic cholecystectomy.Methods From Aug 1998 to May 2001,five patients among 3610 cases.tge jandice occurred in Minitraumatic technique such as endoscopic retrograde cholangiopancreaticograph(ERCP)and endoscopic sphinctectomy(EST).Results For the five patients,Ultrasound and ERCP showed that there were stones remained in common bile duct with stricture of terminal common bile duct.The stones were taken out after EST for three patients.One patient was failed to remove the stone at first time,and the stones were taken out by the second ERCP and lithotripsy five days later.The other patient underwent laparotomy and exploration of common bile duct.Conclusion Most postcholecystectomy jaudice due to extrahepatic bile duct obstruction caused by common bile duct stones combined with stricture of terminal common bile duct.It can be succesfully diagnosed and managed by means of endoscopic intervention.